A Smart Mobile Application to Monitor Visual Function in Diabetic Retinopathy and Age-Related Macular Degeneration: The CLEAR Study

Khurana, Rahul N.; Hoang, Carol; Khanani, Arshad M.; Steklov, Nikolai; Singerman, Lawrence J.

doi:10.1016/j.ajo.2021.03.033

Cited by 22 publications

(18 citation statements)

References 15 publications

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“…Our finding that HM was acceptable to patients and could be used to assess the stability of nAMD and monitor associated changes in vision is in keeping with other related research about the monitoring of visual function using digital testing [ 48 , 49 , 50 , 51 ]. For example, a pilot study of a tablet-based programme for detecting progression in patients with intermediate AMD indicated good agreement between HM and clinic-based testing [ 49 ].…”

Section: Discussionsupporting

confidence: 88%

Patient Acceptability of Home Monitoring for Neovascular Age-Related Macular Degeneration Reactivation: A Qualitative Study

O’Connor

Treanor

Ward

et al. 2022

IJERPH

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Neovascular age-related macular degeneration (nAMD) is a chronic, progressive condition and the commonest cause of visual disability in older adults. This study formed part of a diagnostic test accuracy study to quantify the ability of three index home monitoring (HM) tests (one paper-based and two digital tests) to identify reactivation in nAMD. The aim of this qualitative research was to investigate patients’ or participants’ views about acceptability and explore adherence to weekly HM. Semi-structured interviews were held with 78/297 participants (26%), with close family members (n = 11) and with healthcare professionals involved in training participants in HM procedures (n = 9) (n = 98 in total). A directed thematic analytical approach was applied to the data using a deductive and inductive coding framework informed by theories of technology acceptance. Five themes emerged related to: 1. The role of HM; 2. Suitability of procedures and instruments; 3. Experience of HM; 4. Feasibility of HM in usual practice; and 5. Impediments to patient acceptability of HM. Various factors influenced acceptability including a patient’s understanding about the purpose of monitoring. While initial training and ongoing support were regarded as essential for overcoming unfamiliarity with use of digital technology, patients viewed HM as relatively straightforward and non-burdensome. There is a need for further research about how use of performance feedback, level of support and nature of tailoring might facilitate further the implementation of routinely conducted HM. Home monitoring was acceptable to patients and they recognised its potential to reduce clinic visits during non-active treatment phases. Findings have implications for implementation of digital HM in the care of older people with nAMD and other long-term conditions.

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Section: Discussionsupporting

confidence: 88%

Patient Acceptability of Home Monitoring for Neovascular Age-Related Macular Degeneration Reactivation: A Qualitative Study

O’Connor

Treanor

Ward

et al. 2022

IJERPH

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“…92 Home OCTs and smart phone apps measuring vision, contrast sensitivity, ocular alignment, subretinal fluid, and metamorphopsia may be used for at-home monitoring and earlier detection of disease. [93][94][95] Fundus photographs, slit lamp photography, laser flare photometry, fluorescein angiography, OCTs, and OCTAs can be obtained with minimally trained staff, be remotely operated, or be self-operated. 93,96 Artificial intelligence (AI) or a remote screener can help evaluate the images.…”

Section: Teleophthalmologymentioning

confidence: 99%

Ocular and Systemic Complications of COVID-19: Impact on Patients and Healthcare

Leung¹,

Fan²,

Flynn³

et al. 2022

OPTH

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There is increasing information available about the effects of the SARS-CoV-2 virus on the systemic and ocular health of patients, as well as the effects of delayed health care. This mini-review summarizes the potential complications and treatments of COVID-19. Systemic findings include respiratory illness, risk of thromboembolic events, and neurologic findings. Some patients may develop persistent symptoms even after the infection resolves. Effective treatment options include glucocorticoids, antivirals, interleukin-6 antagonists, monoclonal antibodies, Janus kinase inhibitors and vaccines. Potential ocular findings of COVID-19 include conjunctivitis, cranial nerve palsies, and microvascular changes in the retina; most symptoms resolved over time. During the lockdown periods, teleophthalmology was utilized to triage non-urgent issues; patients who did present to emergency departments tended to have more severe disease with worse visual prognoses. While transient delays in outpatient ophthalmic care may be tolerated in some patients, others experienced significant vision loss with interruptions in treatments. Resumption of ophthalmic care as soon as possible may help mitigate the effects of delayed care due to the pandemic.

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“…ing has been done exclusively in a clinical setting under the guidance of a trained professional, but in recent years, various options have been created for testing outside of the clinic, including paper charts, [7][8][9][10] web-based tests, [11][12][13][14] and smartphone applications. [15][16][17][18][19][20][21][22][23][24] Many commercially available VA tests are not validated before public release, and many applications require users to pay a fee, making clinical application unrealistic for some patients. 25 A 2015 review of 11 Snellen chart iPhone applications found significant variability in application accuracy and validation methods.…”

mentioning

confidence: 99%

Validation of Home Visual Acuity Tests for Telehealth in the COVID-19 Era

et al. 2022

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uring the initial portion of the COVID-19 pandemic, eye care professionals needed to reduce the risk of exposure to patients while continuing to provide highquality health care. The Casey Eye Institute at Oregon Health and Science University saw a decrease in clinic visits to 25% of prepandemic levels in April 2020 and did not return to baseline until March 2021. 1 With the need to limit clinic visits and an increase in the Centers for Medicare & Medicaid reimbursement for telehealth services, 2 teleophthalmology has played a critical role in responding to the COVID-19 pandemic. 1,3,4 Although published data are limited regarding teleophthalmology during the pandemic, a study looking at ophthalmology visits insured by Blue Cross Blue Shield of Michigan found a 4-fold increase in virtual visits compared with baseline data from the first 3 months of the pandemic. 5 A study at Casey Eye Institute demonstrated positive clinician attitudes with telehealth implementation during the pandemic 1 ; however, access to an easy-to-use, validated at-home visual acuity (VA) test for adults limited telehealth care.With increased use of telehealth technology, it is crucial to ensure that quality of care remains optimal. A key factor in evaluating and treating patients during eye care visits is the VA measurement. During a clinical encounter, this measurement is taken at specific distances using standardized charts, including Snellen, Early Treatment Diabetic Retinopathy Study (ETDRS), HOTV, and Tumbling E charts. 6 Historically, VA test-IMPORTANCE Visual acuity (VA) is one of the most important clinical data points in ophthalmology. However, few options for validated at-home VA assessments are currently available.OBJECTIVE To validate 3 at-home visual acuity tests in comparison with in-office visual acuity.DESIGN, SETTING, AND PARTICIPANTS Between July 2020 and April 2021, eligible participants with VA of 20/200 or better were recruited from 4 university-based ophthalmology clinics (comprehensive, cornea, glaucoma, and retina clinics). Participants were prospectively randomized to self-administer 2 of 3 at-home VA tests (printed chart, mobile phone app, and website) within 3 days before their standard-of-care clinic visit. Participants completed a survey assessing usability of the at-home tests. At the clinic visit, best-corrected Snellen distance acuity was measured as the reference standard. MAIN OUTCOMES AND MEASURESThe at-home VA test results were compared with the in-office VA test results using paired and unpaired t tests, Pearson correlation coefficients, analysis of variance, χ 2 tests, and Cohen κ agreement. The sensitivity, specificity, positive predictive value, and negative predictive value of each at-home test were calculated to detect significant VA changes (Ն0.2 logMAR) from the in-office baseline. RESULTSA total of 121 participants with a mean (SD) age of 63.8 (13.0) years completed the study. The mean in-office VA was 0.11 logMAR (Snellen equivalent 20/25) with similar numbers of participants from the 4 clinics....

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A Smart Mobile Application to Monitor Visual Function in Diabetic Retinopathy and Age-Related Macular Degeneration: The CLEAR Study

Cited by 22 publications

References 15 publications

Patient Acceptability of Home Monitoring for Neovascular Age-Related Macular Degeneration Reactivation: A Qualitative Study

Patient Acceptability of Home Monitoring for Neovascular Age-Related Macular Degeneration Reactivation: A Qualitative Study

Ocular and Systemic Complications of COVID-19: Impact on Patients and Healthcare

Validation of Home Visual Acuity Tests for Telehealth in the COVID-19 Era

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